Objectives – Care of the Unconscious Patient

Knowledge Objectives

List the main signs and symptoms of concussion and outline the reason for on-going observation post injury

List the main signs and symptoms of (cerebral) compression

Describe the management of a head injured patient

Describe the management of a suspected spinal injury

List steps to care for the general well-being of an unconscious patient.

Attitudinal Objectives

At the completion of this module, the student will be able to:

Demonstrate an ability to empathise with patients who may not appear to be fully conscious, in a non-judgemental and compassionate manner

Demonstrate an ability to respond to the needs of patients, showing an appreciation for the effects of pain and fear.

Skills Objectives

At the completion of this module, the student will be able to:

Demonstrate how to assess a patient’s conscious level

Demonstrate how to examine a patient’s head

Demonstrate how to manage a patient’s airway using the head tilt & chin lift

Demonstrate how to provide advice to a patient with a suspected spinal injury

Demonstrate how to care for an unconscious patient’s general wellbeing.

Patient Assessment

The Primary Survey

In any given first aid event, our first challenge will always be a successful patient assessment. For First Aid Responders this has been broken down into:

The Primary Survey

The Secondary Survey

The Primary Survey

The objective of the primary survey is to ensure your own safety and to determine any immediate life-threatening impairments. The process is best described using the helpful acronym DRABC.

D = Danger?

Before making any attempt to assist your own safety must come first. You cannot help if you become ill or injured yourself. At work this could mean cutting the power supply to machinery or stopping vehicles such as lorries, forklifts, tractors etc. In the community and at home it may translate into stopping a football match or turning off cookers. Often there are no hazards present, the most common precaution is to simply put on a pair of latex gloves to protect from body fluids. Nevertheless it will always remain a case of ‘Safety First’.

R = Response

Check the patients response. Tell them your name and ask if you can help? They may or may not respond. We could tap them on the shoulders and ask if they can hear you or open their eyes? A patients level of responsiveness can be gauged using the AVPU scale which we will describe in more detail later on. At this point it is helpful to note that if the patient responds in an alert fashion, able to speak, this means that their airway is open and they are breathing – a good sign!

A = Airway

If the patient is unresponsive you can ensure their airway is open by lifting their chin and tilting their head back. You can also look into their mouth to see if there is anything obviously blocking their airway. However do not perform a blind finger sweep. Only take something out of the patients mouth if you can see it and it is easy to do so. Choking is a scenario in which a person may be responsive but their airway is blocked. For guidelines on how to respond check out our section on choking.

B = Breathing

Watch the patients chest to see if they are breathing. Take a minimum of 5 but no longer than 10 seconds to check for chest rise. If the patient is not responding and they are not breathing, call 999/112 & start CPR beginning with chest compressions.

C = Circulation

Is the patient bleeding heavily? If so we need to treat immediately by calling 999/112 & applying direct pressure to the wound.

CPGs Patient Assessment – The Primary Survey:

The Secondary Survey

The objective of a secondary survey is to identify any further illness or injury that may require treatment. There are several components to help first aiders conduct a successful secondary survey as part of their patient assessment:

SAMPLE

Vital Signs

Head to Toe Survey

SAMPLE

Although not intended as a sequential set of checks in practice, SAMPLE provides a useful way of learning the key components of a secondary survey. It stands for:

S = Signs & Symptoms

Signs relate to what can you see, hear, feel or smell to indicate the persons condition? For example you may see blood on clothing or hear wheezing in the patients breathing. Symptoms refer to what the patient can tell you about how they feel i.e. dizzy, cold, nauseous.

A = Allergies?

Ask the patient if they have any allergies. This could explain difficulty breathing in relation to a bee sting or after eating a food they have an allergy to. It may also reveal a contraindication to medication, for example aspirin.

M = Medications?

Ask the patient if they are taking any medications that they need you to help with. This could be an inhaler to relieve an asthmatic episode or tablets to relieve angina. We can help by getting them for the patient.

P = Pertinent Medical History

Does the patient suffer from any known medical condition e.g. epilepsy or has the patient experienced the same symptoms before e.g. chest pain.

L = Last Meal

What did they last eat or drink & when?

E = Events that led to the incident

Can the patient tell you what led to their condition or was anyone else around that can tell you?

CPGs Patient Assessment – Secondary Survey Trauma:

Vital Signs

There are 6 vital signs that with a quick check can deliver further information about our patients condition. These are:

Circulation

A pulse rate between 60-100 beats per minute is normal adult range. The pulse should also be beat in a regular rhythm.

Breathing

A breathing rate between 12-20 is normal adult breathing rate. The rhythm should be regular with no sounds.

Blood Pressure

Blood pressure is best measured using an appropriate monitor or device. A recording of 120/80 is normal. Blood circulation can also be checked by performing a capillary refill test.

Colour

A persons skin colour can give an indication of illness eg cyanosis is a blue tinge to lips, nose or extremities and may indicate a low blood oxygen levels.

Temperature

A patients temperature can be quickly checked by placing your hand on their forehead. A more precise measurement may be taken with a thermometer. There are different kinds of monitor so make sure you are using yours correctly. Armpit, ear, forehead are common areas that monitors can reveal a persons body temperature. This could indicate fever, hyper or hypothermia. Normal body temperature is 37 degrees Celsius.

Level of Consciousness

The manner in which the patient responds can give a indication of their level of consciousness, often abbreviated LoC. The AVPU scale is a commonly used gauge of a persons level of consciousness. More information on this can be gained by checking out the module Altered Levels of Consciousness.

CPGs Patient Assessment – Secondary Survey Medical:

Head to Toe Survey

The title ‘head to toe’ survey can feel quite daunting for the First Aid Responder. Contrary to assessing the patient fully from head to toe, a better description is to assess visually and physically as the event history dictates. Depending on the events leading to the injury or illness as well as the signs and symptoms, you may feel it helpful to examine a particular area of the patients body to determine if there are any further signs indicating the need for treatment. These can include:

Head & Neck area

Deformities, blood, cuts or any sign of trauma. Fluid oozing from ear or mouth. Pupil size and reaction.

Torso & Extremities

Again checking visually for deformities, blood or any sign of trauma. A physical check may include very gently checking tenderness appropriately or asking the patient to clench fingers and toes in order to check sensation or motor control.

One of Ireland’s Leading Workplace Health Providers

Let's Work Together

About Healthco

Our mission is to keep your employees healthier for longer in a way that is sustainable for our clients business model. Our team are experts in their field and they are highly qualified in the areas of health and safety, health promotion and healthcare.